Thank you for your support of WiHPCA! Please complete the agency membership application thoroughly. A benefit to the agency membership is you may include an unlimited number of employees and/or staff. These individuals will have access to all of WiHPCA's benefits when they are included with the agency. WiHPCA annual dues are calculated at $0.12/patient hospice day with a minimum of $500 and maximum of $8000. To accurately invoice your agency, please submit the number of agency hospice days from October 2022 - Sept 2023. Once we receive your application, you will receive 2024 dues invoice based on the number of patient hospice days submitted.
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Total number of patient hospice days from Oct 2022 - Sept 2023:
Employees you would like added to your 2024 WiHPCA agency membership. Please include full name, position and email address.
Should be Empty: